Triptans May Offer Some Migraine Relief

DEAR DR. DONOHUE: Please write about migraine headaches. My granddaughter, age 22, suffers from them. She is a college student and also works. What causes these headaches? — E.F.

ANSWER: Migraines start out as one-sided throbbing headaches that can last 24 or more hours. As time passes, the entire head might hurt. Along with the pulsating pain, nausea often strikes, and sometimes people have to vomit. Migraine sufferers are sensitive to light and sound, so they seek a quiet, dark room where they can lie down.

The cause of these headaches is controversial. A popular theory is that a wave of slow electrical activity spreads over the brain and inflames its coverings, which produces the pain.

The above “cause” of migraines, I am sure, is not what you wanted. You want to know what brings them on. Triggers for migraine include too little or too much sleep, skipping meals, strong odors, bright lights and loud music. Women often find that menstrual periods will usher in the headaches. Stress, both physical and emotional, can start them. Foods that often serve to initiate a migraine are chocolate, cheeses, fatty foods, sausage, salami, oranges, tomatoes, onions, red wine, peanuts and hot dogs.

In the past 20 years, triptans have brought a marked change in the treatment of migraines. Sumatriptan (Imitrex), zolmitriptan (Zomig), almotriptan (Axert), rizatriptan (Maxalt), frovatriptan (Frova) and naratriptan (Amerge) can control severe migraines and are available as pills, nasal sprays and self-administered injections. For less-intense pain, aspirin, Tylenol, ibuprofen and naproxen are sufficient.

When migraines recur with disrupting regularity, preventive medicines have a place in treatment. They include propranolol (Inderal) and verapamil.

The booklet on headaches deals with the common varieties, including migraines. Readers can obtain a copy by writing: Dr. Donohue — No. 901W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My biggest health problem, if you can call it a health problem, is getting to sleep at night. I lie in bed for what seems an eternity before I fall asleep. A friend told me she had the same problem and cured it with melatonin. I’d like to try it if it’s safe. Is it? I am 76 years old and would like a few years of good sleep. — T.R.

ANSWER: Melatonin is a hormone secreted by the pineal gland, a small gland attached to the brain. It conditions the body to adapt to day-night cycles. Melatonin secretion is 10 times greater at night, with peak secretion occurring between 11 p.m. and 3 a.m.

Evidence suggests that this hormone shortens the time it takes to fall asleep and lengthens the time spent in uninterrupted sleep. Melatonin production wanes with age, and its lack could explain your sleep problems.

It also has been used for shift workers to get their brains and bodies conditioned to new sleep-wake cycles, and travelers sometimes take it to prevent jet lag.

Melatonin isn’t sold as a drug, so it’s not closely supervised. Serious side effects haven’t been reported. A safe starting dose is 0.2 mg to 0.3 mg.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.